The Newborn Blood Spot Test

One of the first medical tests your newborn baby has is the heel prick test. It is also called the blood spot test and forms part of the UK national screening programme. Further information on the programme can be found here.

You may have heard stories from other parents about how upsetting they and their baby found the test. It does involve a small cut on the baby’s foot but I don’t believe it has to be distressing for parents or baby. In fact, I always aim to cause as little discomfort as possible. I warn parents that the baby is likely to be more upset about getting naked to be weighed that they are about getting the test done.

What is the Blood Spot Test for?

The blood spot test collects a small amount of blood and checks it for 9 different health conditions.

Some of these conditions are metabolic. This means that the baby may be born unable to digest a certain protein or fat. If the baby’s diet included it, the undigested protein or fat would build up to levels in their body which would cause them harm. However, if we find out that the baby has that condition we can give them a diet without the particular protein or fat and the baby is absolutely fine.

The other conditions we look for are:

• Cystic Fibrosis, a condition which causes problems in our lungs and digestive systems. The baby may need physiotherapy and medications
• Sickle Cell or Thalassemia, a condition where blood cells have an unusual shape. It is more common in families with African ancestors.
• Hypothyroidism, which is where the baby’s thyroid doesn’t produce enough of the hormone thyroxine. The baby may need medication.

How to help reduce baby’s distress

So how can I promise that your baby will be more distressed by the weighing that follows the heel prick test than by the test itself?

Well, in order to collect the right amount of blood, we need the foot to have a good blood supply. Have you noticed that your baby always has cold hands and feet? This is very normal and important as the baby is keeping most of its blood in the important areas of its brain and chest. This means that normally we would have to press quite hard and wait for ages to collect the right amount of blood from the baby’s foot. It’s this drawn out pressure and holding of the foot that causes the most distress.

The key to reducing distress is warm feet.

I always ask parents to put socks on their baby before I visit. Sometimes that means they do it in the middle of the night. I also ask them to put lots (more than 2 or 3) of pairs of socks on the baby, as well as booties, as well as wrapping them in a cosy blanket. No kidding! Sometimes the baby’s feet look twice their size, but I’d rather that for a short time so the baby doesn’t find the test upsetting, than that the baby looks fashionable!

If for some reason the baby’s feet are still cold, or if the parents have forgotten to put on any or enough socks, we still have options to warm the feet up.

My next action is to ask you for a mug or jug or bowl filled with really really warm water. I don’t want lukewarm water. I want the kind of water that turns your fingers red when you put them into it. You should be able to put your fingers into it, though, not find them burning!

The reason your fingers turn red is because the blood flows into them to cool them down. So yes, my plan is to put the baby’s foot into the water until it turns red. Their first experience of paddling! After about a minute of paddling in good warm water, I find that the babies’ feet don’t need lots of pressure to provide enough blood. It also flows quickly so that the test is over quickly too.

Other things you can do to help

Cuddle your baby during the test. They already know you and your scent and your voice. Being held by you is always going to calm them more than if the midwife holds them.

Hold them in an upright position. Gravity will help with the blood flow to their foot. This means that cuddling them across your chest won’t be as effective as holding them over your shoulder or sitting them up in your lap so their feet dangle down over the side of your legs.

Speak gently and soothingly to them. A calm soothing sound such as ‘shush’ or ‘sssshhhh’ can really comfort a baby in distress.

Feed the baby or provide a pacifier for them to suck. Sucking is always a comforting experience for babies. Letting them feed will also keep them close to you which will help keep them calm.

Results of the Blood Spot Test

The results of the test are usually sent out in the post to you if everything is ok. It can take up to eight weeks for these results to arrive. If you still haven’t heard anything, ask your health visitor.

Any abnormal or unexpected results are followed up quickly by professionals. The midwife may return to repeat the test and collect extra blood for further checks. You may be asked to attend the children’s department of your local hospital for further tests. The Health Visitor may come to discuss the results with you or may give you details of a specialist nurse who can talk you through the results in more detail.

The conditions we check for can be found in more detail on the NHS website here, or in the screening booklet your midwife gave you at the beginning of your pregnancy.

Please be reassured that the conditions we are looking for are very rare and entirely manageable. You shouldn’t be overly anxious about the health of your baby if he or she is feeding well and behaving normally. If you do have any concerns about your baby’s health please speak to a health professional as soon as possible.